Me kōrero tātou mō te Pouri Ātete-Maimoatanga!

Tērā pea kua pāngia koe e te pouri mō ngā marama, tae noa ki ngā tau. Kua kite koe i te tākuta, ā, kua tangohia e koe ehara i te kotahi engari e rua ngā rongoā mō te wā kua whakaritea, engari kāore anō tō pouri, tō kore hiahia ki tetahi mea, tō pouri rānei e kore e taea te mau. Kātahi pea ka pāngia koe e te mea e kiia nei ko te "Treatment-Resistant Depression" (TRD). Kaua e mataku ina rongo koe i taua ingoa, ehara i te mea "kāore e taea te rongoā." Heoi, ka roa pea te wā ki te kimi i te rongoā tika māu. Me kōrero tātou mō tēnei mea me te taipitopito me te tino māmā i tēnei rā.

He aha tēnei mea e kīia nei ko te pouri ātete-maimoatanga?

He whakarāpopototanga noa iho, ko te 'pōuri ātete-maimoatanga' he wāhanga iti o te Mate Pōuri Nui (MDD). Ka kitea tēnei mate ina pāngia koe e te pōuri, ā, kei te tango koe i te iti rawa e rua ngā rongoā ārai pouri tuatahi, i te horopeta kua tohua me te wā kua tohua (neke atu i te 6 ki te 8 wiki) , engari kāore ō tohu e pai ake ana.

Ko te tikanga, ka tohua tuatahitia e ngā tākuta ngā rongoā mai i te rōpū `SSRI` (Selective Serotonin Reuptake Inhibitors) `SNRI` rānei (Serotonin and Norepinephrine Reuptake Inhibitors). Nā te mea, ki te whakaritea ki ētahi atu rongoā ārai pouri, he iti ake ngā pānga taha o ēnei, ā, kāore i te tino kino ngā pānga taha. I ētahi wā, ahakoa te hunga i pai te urupare ki ngā rongoā ārai pouri i mua, ka pāngia pea rātou e te `TRD` i muri mai. Ahakoa te ingoa, he maimoatanga anō hoki mō tēnei, engari ka roa pea te wā ki te kimi i te mea tika māu.

He pēhea te noa o tēnei āhuatanga?

I mōhio koe tata ki te 30% o te hunga kua tāpaetia he mate pouri nui (MDD) ā, kua rongoatia mōna, he TRD anō hoki? Ko te MDD tētahi o ngā mate hauora hinengaro tino noa o te ao. Ka pāngia e te 5% me te 17% o te tangata i tētahi wā o ō rātou oranga. Nō reira, kia mahara kāore koe i te mokemoke.

He aha ngā tohu o tēnei?

He rite tonu ngā tohu o te hunga whai `TRD` ki te hunga whai `MDD`. Arā, ko ngā āhuatanga pēnei i te pouri tonu, te pouri, ngā mate moe (kāore e moe, kāore rānei e taea te moe), me ngā huringa o te hiahia kai (kāore e hiahia ki te kai, he nui rawa rānei te kai).

Heoi, he mea noa ake ēnei i waenga i te hunga whai `TRD`:

• Ka kaha haere ngā tohu.
• Ka roa te wā e pāngia ai te pouri.
• He āhuatanga e kiia nei ko te "Anhedonia." Ko tōna tikanga kāore e taea e koe te whiwhi i tētahi ahuareka mai i ngā mea i hari ai koe, i te koa rānei i mua. Whakaarohia, kei te whakarongo koe ki tāu waiata tino pai, kei te kōrero rānei ki tētahi hoa, engari kāore he kare ā-roto e pā ana ki a koe.
• Te pikinga ake o te auau o ngā wā pouri i te oranga o te tangata.
• Te nui rawa o te manukanuka .
• Whakaaro whakamomoriA he nui ake ngā tūponotanga ki te whakamātau.

He mea nui: Mena kei te whakaaro koe, kei te whakaaro rānei tētahi e mōhio ana koe ki te whakamomori, waea atu ki te Rārangi Whakamomori me te Rārangi Ora mō ngā Wā Pōuri i te 988. Kei te wātea tētahi hei āwhina i a koe, 24 hāora ia rā. Ka taea hoki e koe te toro atu ki tētahi tākuta, ki tētahi kaitohutohu hauora hinengaro rānei i te wā e taea ai.

He aha tēnei e tupu nei? He aha ngā take?

Ina hoki, kāore anō kia tino mōhiotia e ngā kairangahau he aha te take kāore ai te pouri o ētahi tāngata e aro ki te rongoā. Pērā i te korenga o te take kotahi mō te pouri, he maha ngā āhuatanga, tae atu ki ngā awe ira me ngā huringa o ngā matū roro, e whai wāhi ana ki tēnei āhuatanga.

Engari, ki tā rātou whakaaro, ka pā nui te ahotea mau tonu ki tēnei. Me pēhea koe e mōhio ai? He pūnaha nui kei roto i ō tātou tinana e kiia nei ko te `Hypothalamic-Pituitary-Adrenal (HPA) axis. Koinei te mea e āwhina ana i a tātou ki te urutau ki te ahotea. Nō reira, ka taea e te ahotea tonu te whakarerekē i te mahi a tēnei `HPA` axis. Ina tupu tēnā, ka nui haere te kino o te pouri, ā, ka uaua ake te rongoā.

Ko wai te mea tino mōrearea?

Kua whakaatuhia e ngā rangahau, ki te whakaritea ki te hunga whai MDD e aro ana ki te rongoā, he nui ake te tūponotanga o te hunga whai TRD ki te pāngia e ēnei āhuatanga tinana e whai ake nei:

• Ngā mate pūnaha ārai mate (arā, ngā mate e whakaekehia ai e te pūnaha ārai mate o te tinana a ia anō).
• Te mate tairoi.
• Mate ngakau.
• Te mate roro (arā, ngā mate e puta ana i roto i ngā oko toto e tuku toto ana ki te roro).

Ehara i te mea ka pāngia te hunga katoa e pāngia ana e ēnei mate e te TRD, engari he āhuatanga mōrearea pea ēnei.

Me pēhea te tautuhi tika a ngā tākuta i tēnei?

Kāore i te tino mārama te tautuhi i te mate o te `TRD`. Heoi, ko te nuinga o ngā tākuta e tautuhi ana i tēnei mate ina kāore anō koe kia kite i tētahi whakapainga i roto i ō tohumate pouri i muri i te tango i te iti rawa e rua o ngā rongoā ārai pouri e whakamahia ana e koe i tēnei wā. He maha ngā tākuta e whakaaro ana ki ēnei hei rongoā ārai pouri tuatahi:

• Ngā `SSRI`
• Ngā `SNRI`
• Pūporopiona
• Mirtazapine

I te nuinga o te wā, me whakamahi koe i tētahi rongoā mō te ono ki te waru wiki pea kia kite ai mēnā e whai hua ana, kāore rānei.

Mena kei te tango koe i ngā rongoā e rua, ā, kāore anō kia pai ake te āhua, ka tukuna pea koe e tō tākuta ki tētahi tohunga hinengaro . I reira, ka tangohia e ia he hītori hauora me te hauora hinengaro. Kei roto pea i ēnei:

• Ngā rongoā katoa e tangohia ana e koe i tēnei wā (nā te tākuta i whakahau, ngā rongoā kore-tohu, ngā rongoā otaota, tae atu ki ngā rongoā narkotika)Pātai atu mō tēnei. Nā te mea ka taea e ētahi rongoā te whakararuraru i te whai huatanga o ngā rongoā ārai pouri, te whakanui ake rānei i te pouri.
• Ka matapakihia e rātou mēnā kei te tika tō tango i ngā rongoā ārai pouri me ētahi atu rongoā, me te mea hoki kua whakaritea .
• Ka tirohia e rātou mēnā kua whiwhi koe i te rongoā hinengaro, i te kōrerorero rānei , ā, mēnā kua āwhina i a koe ki te whakatau i tō pouri.
• Ka taea e ētahi āhuatanga tinana, pērā i te mate tairoi me te mamae mau tonu, te whakararu, te whakanui rānei i te pouri, nō reira ka tirohia mēnā kei te pouri.
• Ka tirohia e rātou ngā raruraru pēnei i te whakamahinga tarukino .
• Whakaarohia mēnā he nui ake te tūponotanga kia tautuhia ō tohumate ki tētahi atu mate hauora hinengaro (hei tauira, te mate hinengaro rua, te mate tuakiri rānei) .

I muri i te matapaki i ēnei mea katoa me te whakahaere i ngā whakamātautau e tika ana, ka whakatauhia e tō tākuta mēnā kei a koe te 'TRD'. Kātahi ka āwhina ia i a koe ki te kimi i te huarahi maimoatanga pai rawa atu māu.

Nā, he aha ngā maimoatanga mō tēnei?

He maha ngā huarahi hei whakahaere i te `TRD`. Tērā pea ka roa te wā e puta ai ngā hua e hiahiatia ana, engari kaua e mutu te tumanako.

Tuatahi, ka whakamātau pea tō tākuta hinengaro i ēnei mea:

• Hoatu te rongoā ārai pouri e roa ake ana te wā e pau ana ki a koe i tēnei wā.
• Whakanuia te horopeta o te rongoā ārai pouri raina tuatahi e tangohia ana e koe i tēnei wā.
• Tāpirihia he rongoā ārai pouri mai i tētahi atu akomanga. Kātahi ka rua ngā rongoā e tangohia ana e koe i te wā kotahi.
• Whakatenatenahia koe kia tūtaki ki tētahi tohunga hinengaro , kia whiwhi ai i te rongoā hinengaro . Tērā pea ka roa te wā ki te kimi i tētahi kaiwhakaora hinengaro e "mārama ana ki a koe". He rerekē anō hoki ngā momo rongoā hinengaro.

He aha tāu e mahi ai i muri mai ina kore e whai hua ngā maimoatanga noa?

Ki te kore e whai hua ēnei tikanga taketake, ka tūtohu tonu tō tākuta hinengaro i tētahi momo rongoā rerekē, i tētahi huinga rongoā, i tētahi tikanga maimoatanga rerekē rānei.

I tēnei wā, e rima ngā rongoā kua whakaaetia e te US Food and Drug Administration (FDA) mō te TRD:

• Aripiprazole (Abilify®) me Brexpiprazole (Rexulti®): He rongoā antipsychotic o te whakatupuranga tuatoru ēnei. Ka taea e rāua te whakaiti i ngā tohu o te pouri mā te pā ki ngā taumata o te serotonin me te norepinephrine i roto i tō roro.
• Quetiapine (Seroquel®) me Olanzapine (Zyprexa®): He rongoā antipsychotic o te reanga tuarua ēnei. Kua whakaaetia te Quetiapine hei maimoatanga tāpiri mō te TRD me ngā antidepressants. Kua whakaaetia te Olanzapine ina hoatu ngātahitia me te Fluoxetine (Prozac®). Ka āwhina rāua ki te whakaiti i ngā tohu o te pouri mā te pā ki ngā taumata dopamine i roto i te roro. Ka taea hoki e ēnei rongoā te whakamoe.
• Rehu ihu Esketamine (Spravato®): He mea hanga tēnei mai i tētahi matū e kiia nei ko te ketamine. I whakaaetia e te FDA i te tau 2019 hei rongoā tāpiri mō ngā pakeke e pāngia ana e te TRD, me tētahi rongoā ā-waha hei ārai i te pouri. Ka taea e te Esketamine te tīmata ki te whakaiti i ngā tohu o te pouri i roto i ngā haora e rua i muri i te tangohanga. Heoi, nā te mea ka taea e ia te whakararuraru i te hiamoe nui (whakamoe), te wehewehe (te ngaronga o te mōhio ki tō wāhi, ki te aha rānei e tupu ana), ā, nā te mea ka taea te whakamahi kino, ka hoatu noa tēnei rongoā i raro i te tirotiro a te tākuta i roto i te whare hauora. Ka aroturukihia koe e ngā tākuta mō ngā haora e rua i muri i te tangohanga o te rongoā.

He aha atu ngā maimoatanga kua whakaaetia e te FDA?

Kua whakaaetia hoki e te FDA ēnei maimoatanga mō te TRD:

• Te whakaora hiko-ā-rangi (ECT): He tikanga hauora tēnei. I roto i tēnei, ka tukuna ngā hiko tino ngawari mā roto i tō roro, ka puta he hopu iti. Ka whakaoho tēnei i ngā pūtau io, ā, ka puta he huringa i roto i te roro ka whakapai ake i tō wairua.
• Te whakaohooho aukume whakawhiti angaanga auau (rTMS): He maimoatanga kore-whakaeke tēnei. I roto i tēnei maimoatanga, ka whakamahia he koiri aukume hei awe i te mahi hiko tūturu o tō roro. Ka taea e tēnei te whakaputa huringa ki ngā wāhanga motuhake o te roro ka pā ki tō wairua.

He kōwhiringa maimoatanga anō kei reira?

He maha atu anō ngā huarahi maimoatanga mō te TRD, engari kāore pea ēnei i te whānui te wātea, kei roto rānei i te wāhanga rangahau:

• Te whakaohooho roro hōhonu (DBS): He tikanga hauora anō hoki tēnei. I konei, ka tukuna he iahiko ngawari ki tētahi wāhanga motuhake o tō roro. Ka whakaohohia e tēnei hiko ngā pūtau roro i taua wāhi, ka taea te whakaora i ētahi mate, tae atu ki te TRD.
• Lithium (Eskalith®): Kua whakaatuhia e ngā rangahau ka taea e te tango i te lithium me te rongoā ārai pouri (hei tauira, citalopram) te whakapai ake i te TRD.
• `MAOI` (Ngā aukati monoamine oxidase): Koinei ngā rongoā tuatahi mō te pouri i kitea. Heoi, nā te maha o ngā here mō te kai, ngā pānga taha, me ngā āwangawanga mō te haumaru, ka tohua noa ēnei e ngā tākuta ina kore e angitu ngā rongoā katoa mō te pouri.
• Pramipexole (Mirapex®): He rongoā tēnei kua whakaaetia e te FDA mō te mate a Parkinson. Kua whakaatuhia e ngā rangahau ka taea e ia te whakaiti i ngā tohu pouri i roto i te mate a Parkinson. Tērā pea ka āwhina i te hunga whai TRD.
• Te whakaohooho i te io vagus (VNS):I konei, ka whakauruhia he taputapu e tuku ana i ngā pāoro hiko ngawari, auau ki tō roro mā te io vagus i tō kaki. Ka taea e tēnei te whakarerekē i ngā taumata o ētahi 'neurotransmitters' i roto i tō roro e whakahaere ana i tō wairua.

Kei te rangahau hoki ngā kairangahau i te psilocybin, he matū i tangohia mai i ngā harore whakaipoipo, hei rongoā mō te TRD.

He pānga taha kei roto i ēnei maimoatanga?

I te nuinga o te wā, he nui ake ngā pānga taha o ngā rongoā me ngā maimoatanga mō te `TRD` i ngā rongoā ārai mate tuatahi. Waihoki, ka rerekē rawa aua pānga taha. Ka kōrero tō tākuta ki a koe mō ngā pānga taha, ngā raruraru rānei ka pā ki ia whiringa maimoatanga. Kaua e mangere ki te pātai.

Ka taea te ārai i tēnei āhuatanga kei puta?

Nā te mea kāore ngā kaipūtaiao i te tino mōhio he aha te take o te TRD, he uaua ki te ārai i tēnei. Heoi, nā te mea ka whai wāhi pea te ahotea mau tonu ki tēnei, ka taea e koe te mahi i ēnei mea hei whakahaere i tō ahotea:

• Whakakorikori tinana i ngā wā katoa. Ahakoa he hikoi poto noa iho ka taea te whakapai ake i tō wairua.
• Kia pai te moe. He mea nui tēnei mō te hauora whānui.
• Whakamātauria ngā mahi pēnei i te whakaaroaro, te yoga, ngā mahi manawa, me ngā mahi whakangā uaua .
• Whakatakotoria he whāinga mō tō rā, mō tō wiki, mō tō marama hoki. Ina arotahi koe ki ngā mea iti, ka rite koe ki te mea kei a koe te mana whakahaere mō te wā me te wā roa.
• Whakaharatauhia te aro nui me te whakawhetai . Whakaarohia ngā mea pai o tō rā, o tō koiora rānei.
• Whakamātauria te kī "kāo" ki ngā kawenga tāpiri ina pukumahi koe, ina ahotea rānei.
• Kia mau tonu te whanaungatanga ki te hunga e whakamarie ana i a koe, e tautoko ana i a koe i te taha hinengaro, e āwhina ana hoki i a koe ki ngā mahi whai hua.
• Whakaarohia te kōrero ki tētahi kaiwhakaora hinengaro, ki tō tākuta rānei mō te ahotea.

Mena he pouri tōu kāore e taea te rongoā, he aha tāu e taea ai te mahi i te kāinga?

Haunga te rapu awhina hauora ngaio mō te TRD, he maha ngā mea ka taea e koe te mahi i te kāinga hei āwhina i te whakaiti i ō tohumate:

• Te whakakorikori tinana i ia wā, i ia wā.
• Te moe pai (kaua e moe nui rawa, kaua hoki e moe iti rawa).
• Te kai i tētahi kai hauora.
• Āta karohia te waipiro me ngā raau taero ehara i te rongoā. He mea whakapōrearea te waipiro.
• Te whakapau i te wā ki te hunga e arohaina ana e koe, e āwangawanga ana hoki.

Āhea koe me toro atu ki te tākuta?

Kia kitea rā anō e koe tētahi mahere maimoatanga whai hua mō te TRD e whai hua ana māu, tirohia me pēhea te mahi.Me toro atu koe ki tō tākuta i ia wā, i ia wā.

Haunga tēnā, kōrero ki tō tākuta i roto i ēnei āhuatanga:

• Mena ka pāngia koe e ngā pānga taha whakarihariha.
• Ki te kore ō tohu e pai ake, ki te kino haere rānei.
• Ki te mea kei te whakaaro koe ki te whakamutu i tō rongoā (kaua rawa e mutu te tango rongoā me te kore he tohutohu a te taote).

Ko te mea nui rawa atu me kī atu e koe

Ki te mea kei a koe te `TRD`, kia mahara tuatahi ehara i te mea ko koe anake . Tata ki te 30% o te hunga e pāngia ana e te pouri nui he mate tēnei. He maha ngā kōwhiringa maimoatanga mō te `TRD`, engari ka roa pea te wā ki te kimi i te mea e pai ana mōu. Ka tautokohia koe e tō tākuta, e tō tohunga hinengaro rānei i taua haerenga. Kaua e mutu te tumanako. Mā te tautoko me te maimoatanga tika, ka taea e koe te whakahaere i tēnei mate me te ora i te oranga pai ake.

` Te pouri ātete-maimoatanga, te pouri, te hauora hinengaro, TRD, MDD, maimoatanga pouri, mate hinengaro